As part of Pathway’s commitment to bringing you engaging discussions about the genomics industry, we interviewed Cinnamon Bloss, Ph.D., Assistant Professor and Director of Social Sciences and Bioethics at the Scripps Translational Science Institute (STSI). We had the opportunity to discuss with Dr. Bloss the projects she’s currently involved in, and she shared with us some very valuable perspectives about the behavioral impacts of genetic testing, as well as some important insights about the future of genomic medicine.
Dr. Bloss’ research is funded by the National Institutes of Health and is focused on investigating individuals’ behavioral and psychological responses to disclosure of personal genomic information. She is the lead researcher on STSI’s Scripps Genomic Health Initiative, and her work on this project was recently published in the New England Journal of Medicine and has been highlighted at a number of national and international scientific meetings. She has also presented invited testimony on consumer genomics before a Food and Drug Administration Advisory Panel. Dr. Bloss’ other research interests include developing ways of combining genomics with traditional disease risk factors to make predictions about disease development, progression and response to treatment, as well as designing effective health interventions that leverage genomic information. She also conducts genetic association studies and has several collaborations to investigate the genetic underpinnings of neurological, behavioral, and other health-related phenotypes.
Dr. Bloss received her B.A. in Psychology from Smith College, her Ph.D. in Clinical Psychology from the University of California, San Diego, and completed a predoctoral internship in clinical neuropsychology at the University of Florida. Dr. Bloss completed a post-doctoral fellowship in statistical genetics and genomic medicine at The Scripps Research Institute.
Pathway Genomics: What projects are you currently working on that you would like to share with us?
Dr. Cinnamon Bloss: We’re still working on our consumer genomic study that we published a couple of years ago, which is an ongoing study where we’ve been broadly looking at how consumers respond to getting genomic test results delivered directly to them – not going through a physician. We’ve looked at psychological outcomes, impacts on lifestyle, as well as impacts in the area of clinical screening.
“We’ve looked at psychological outcomes, impacts on lifestyle, as well as impacts in the area of clinical screening.”
We published a study last year, looking at our short-term follow-up. What I’m really struck by is that this is such a controversial area right now, and two years ago there were editorials and opinion pieces – even pieces in the lay-media – being published, but there was no data to base it on. We wanted to contribute to the scientific literature and actually do an empirical study, and one very interesting finding from that project was just the lack of real psychological response. One concern people had was adverse psychological consequences and we just didn’t see anything. If you look at the literature on response to testing for single genes and single conditions – such as BRCA testing and testing for ovarian cancer – if you do see an adverse psychological impact, it’s not sustained over the long-term. …So, our results were, overall, quite consistent with the literature that was out there.
That study is still ongoing, and we have a long-term follow-up that we’re working on right now and that we hope will come out soon. We actually have a pharmacogenomic arm of that study as well, which we haven’t published on, but we hope to soon as well.
Since we didn’t find any impact on lifestyle when we looked at this broadly, it sort of begs the question of how we can leverage [genetic testing] as an intervention. I think there’s a few different ways that could be tried. One way might be to literally develop a more targeted genomic test that could serve as a behavioral intervention like you have done with the Pathway Fit® test. …I always think of genomic information as an intervention.
“…it sort of begs the question of how we can leverage [genetic testing] as an intervention. I think there’s a few different ways that could be tried. One way might be to literally develop a more targeted genomic test that could serve as a behavioral intervention like you have done with the Pathway Fit® test. …I always think of genomic information as an intervention.”
PG: You’re going to be working with Pathway on a study later this year. Will you tell our readers more about the study, and what you hope to discover?
CB: We’re going to be working with physicians here at Scripps to provide some type of genetic information to patients, but through their physicians. I hope this study will accomplish a number of aims, but one of the main goals is to focus on and expose barriers to the implementation of genomic medicine. People talk about the eventuality of everyone having their whole genome at birth, it sitting in their medical records, and going back to it and mining it when, for example, people need certain medications.
What I would like for this study to be is not an attempt at replication of past studies, but rather to ask questions that are pertinent when we consider this eventuality. For instance, what happens when you annotate all the coding variants of a person’s genome, and give that information to their physician? How does the patient react to it? How does the physician deal with it? I hope this study can start to expose some of the barriers that we’re definitely going to face – that we’re already facing. That’s my broad hope for the project, but we’re still working out the details.
PG: What’s your opinion about using genetic testing as a component in personalized medicine?
CB: I think the idea of personalized medicine and genomic medicine is a good one. In its ideal form, there is little downside. The problem is that it’s not an idealized situation at this point in time. Before we started our consumer genomics study, I felt like I didn’t really have an opinion, at least regarding direct-to-consumer testing, because I felt like I needed to see data first. That’s how I feel about the integration of genomic testing. There are a lot of areas where we need more research, but there are some areas that are more ready for integration – certainly pharmacogenomic testing in many instances is warranted.
“There are a lot of areas where we need more research, but there are some areas that are more ready for integration – certainly pharmacogenomic testing in many instances is warranted.”
I think before we’re going to get a lot of adoption, there are many stakeholders that are going to need to be brought on board with the appropriate data. …In general, I have a very positive feeling towards it, and I’m looking forward to seeing more research.
PG: Lastly, where do you see genetic testing in the future – for example, 10 to 15 years from now – and how do you think it will impact health care and the daily lives of people?
CB: Ultimately, if we can continue to push the cost down of whole genome sequencing – and it seems like things are moving in that direction – we’re going to have the early adopters, for example, the people who come to Pathway.
Fifteen years out, even if the technology gets there, I still think there are many barriers – electronic medical records, storage of data, education of physicians. I’m optimistic that those things can be overcome, though.
“We might see trends ebbing and flowing. We’ve heard from many others in the field about how changes in the medical profession, the broader insurance industry and other stakeholders – all of those things are going to have to converge before we realize the change that we probably all know is going to be enabled by the technology. …It’s no doubt going to be very exciting.”
We might see trends ebbing and flowing. We’ve heard from many others in the field about how changes in the medical profession, the broader insurance industry and other stakeholders – all of those things are going to have to converge before we realize the change that we probably all know is going to be enabled by the technology.
It’s no doubt going to be very exciting.